Can Metrogyl (Metronidazole) be given?

From the Guidelines

Metrogyl (Metronidazole) can be given for treating infections caused by anaerobic bacteria and certain parasites, with the most recent and highest quality evidence supporting its use in various conditions, including trichomoniasis and bacterial vaginosis, as seen in studies such as 1 and 1. The typical adult oral dose is 500 mg three times daily for 7-10 days, though this varies by condition. For example, for bacterial vaginosis, 500 mg twice daily for 7 days is commonly recommended, as stated in 1. Some key points to consider when prescribing Metrogyl include:

• Common side effects, such as metallic taste, nausea, and headache, as noted in various studies, including 1 and 1.
• The importance of avoiding alcohol during treatment and for 48 hours afterward to prevent disulfiram-like reactions, a precaution highlighted in the context of metronidazole treatment.
• Metronidazole's mechanism of action, which involves entering bacterial cells and being reduced by bacterial enzymes to form toxic compounds that damage bacterial DNA, as understood from its pharmacological profile.
• Contraindications, such as first trimester pregnancy, and cautious use in patients with liver disease or neurological disorders, as indicated by the evidence from 1 and other studies. Before starting treatment, it is crucial to confirm the diagnosis and check for potential drug interactions, especially with warfarin, lithium, and certain anticonvulsants, to ensure safe and effective treatment, as would be the case in real-life clinical practice, considering the most recent guidelines and evidence, such as those provided in 1 and 1.

From the FDA Drug Label

Patients with severe hepatic disease metabolize metronidazole slowly, with resultant accumulation of metronidazole and its metabolites in the plasma. Prescribing metronidazole tablets in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of development of drug-resistant bacteria. Metronidazole is a nitroimidazole and should be used with caution in patients with evidence of or history of blood dyscrasia.

Metrogyl (Metronidazole) can be given, but with caution in certain patients, such as those with:

• Severe hepatic disease
• History of blood dyscrasia It should only be prescribed for proven or strongly suspected bacterial infections or prophylactic indications 2.

From the Research

Metrogyl (Metronidazole) Administration

• Metrogyl, also known as Metronidazole, can be given for the treatment of various infections, including:
  • Trichomoniasis
  • Amoebiasis
  • Giardiasis
  • Anaerobic bacterial infections
• The drug is available in various forms, including oral, intravenous, and rectal suppositories, and can be administered at different dosages depending on the type and severity of the infection 3, 4, 5.

Pharmacokinetics and Efficacy

• Metronidazole has been shown to be highly effective against anaerobic bacteria, with serum, cerebrospinal fluid, and tissue concentrations bactericidal for Bacteroides species attained after usual dosages 3.
• The drug has an oral bioavailability approaching 100% and can attain favorable tissue distribution, including into the central nervous system 6.
• Metronidazole is extensively metabolized by the liver and eliminated by the kidney, with a small amount of the parent drug excreted in the urine 6.

Clinical Uses

• Metronidazole has been used successfully in the treatment of various anaerobic infections, including:
  • Anaerobic infections of the chest, head, gastrointestinal, and female genitourinary tract
  • Anaerobic septicaemia and bacteraemia
  • Non-traumatic brain abscesses
  • Intraabdominal sepsis
  • Pelvic suppuration and necrotizing soft tissue infections 3, 4, 5.
• The drug is also effective in the prophylaxis of elective colorectal surgical procedures and in the treatment of deep abdominal sepsis, usually in combination with another agent, such as an aminoglycoside 5.

Comparison with Other Agents

• Metronidazole is the most active agent available against obligate anaerobes and is likely to be of major value in the treatment of serious infections due to these organisms 3.
• The drug has been compared to other agents, such as clindamycin, chloramphenicol, and penicillin, and has been shown to be highly effective in the treatment and prevention of anaerobic infections 3, 4.